Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Evaluation de la tolérance des administrations sous-cutanées de teicoplanine dans le traitement des infections ostéo-articulaires (résultats préliminaires)

Objectif principal : Nous évaluons la tolérance des injections sous-cutanées (SC) de téicoplanine dans le traitement des infections ostéo-articulaires (IAO). Caractéristiques et lieu de l étude : C est une étude monocentrique, prospective et ouverte réalisée au Centre Hospitalier Universitaire d Amiens. Patients : Nous prévoyons l inclusion de 40 patients adultes, atteints d une IOA à bactérie sensible à la téicoplanine. Intervention : Le traitement est initié par voie intraveineuse. L adaptation posologique est ensuite fondée sur le maintien des concentrations résiduelles de téicoplanine (Cmin) entre 30 et 40 mg/L. Dès que 2 Cmin successives sont comprises entre ces valeurs, le traitement est poursuivi par voie SC pendant 6 semaines. La tolérance au traitement et les Cmin sont évaluées dans les 48h suivant le passage à la voie SC puis tous les 14 jours. Critères de jugement principal : Le patient est considéré tolérant lorsqu il n a présenté aucun des évènements suivants au niveau du site d injection : une douleur intense ou une réaction locale importante (nécrose, tuméfaction, érythème) nécessitant l arrêt du traitement.Résultats : Quatre patients ont été inclus dont 3 ont terminé l étude et 1 est sorti prématurément. La tolérance locale a été acceptable pour les 4 patients. Un des patients a présenté une neutropénie responsable de sa sortie prématurée de l étude. Au cours du traitement, les posologies ont du être réduites afin de maintenir les Cmin entre 30 et 40 mg/L. Conclusion : Le faible nombre de patients inclus ne nous permet pas de conclure concernant la tolérance des injections de téicoplanine par voie SC. Les résultats des Cmin sont en faveur d une bonne absorption de la téicoplanine par voie SC permettant ainsi d obtenir des concentrations plasmatiques suffisantes pour traiter les IOA.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Transplantation rénale et maintien dans l'emploi (étude portant sur 133 transplantations rénales au CHU d'Amiens entre 1995 et 1999)

La transplantation rénale représente chez le plupart des sujets dialysés, la récupération de l'autonomie et le retour à une vie familiale, sociale et professionnelle normale. Dans le but d'apprécier la situation socioprofessionnelle des malades rénaux après la transplantation rénale, nous avons mené dans le service de néphrologie du CHU d'Amiens, de 9 Avril 2001 au 20 Avril 2002, une étude qui a évalué 133 sujets transplantés à l'aide d'un questionnaire composé de 3 parties dont un autoquestionnaire rempli par les transplantés, une étude du dossier médical du greffé et une confrontation des ces derniers avec celles du néphrologue qui assure le suivi des transplantés interrogés. Le résultat de l'étude montre qu'il n'y a pas de différence significative entre la transplantation rénale et la dialyse sur l'activité professionnelle, mais La différence entre les 2 groupes est significative sur l'insertion professionnelle en ce qui concerne l'âge, le sexe, le niveau d'étude, l'intervention du médecin du travail, l'échelle de KARNOFSKY et le département d'habitation. L'enquête montre que ce résultat pourra être améliorer grâce une meilleure connaissance du problème de la part de tous les partenaires sociaux, et une collaboration plus étroite entre les médecins généralistes, les médecins conseils, les néphrologues et les médecins du travail. Le médecin du travail a un rôle essentiel à jouer dans l'information, le suivi, l'aménagement des conditions de travail et le maintien à l'emploi de ces salariés dont on connaît le risque de désinsertionAMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

From nanospheres to micelles: simple control of PCL-g-PEG copolymers amphiphilicity through thiol–yne photografting

International audienceA simple method for the synthesis of a family of poly(ε-caprolactone)-g-polyethylene glycol (PCL-g-PEG)copolymers of controlled amphiphilicity and their use in generating nanospheres or micelles are reported.PCL-g-PEGs with various compositions are prepared from a single strategy relying on a combination ofpost-polymerization modification and subsequent thiol–yne photografting. Alkyne-functional PCL (PCLyne)was first obtained by anionic activation and reaction with propargyl bromide to yield PCL-yne with8% alkyne groups. PEG-thiol is then reacted on PCL-yne under UV activation to yield the targeted graftcopolymer by thiol–yne photoaddition. The advantage of the approach is that control over the compositionis easily achieved, yielding amphiphilic graft copolymers with ethylene glycol/caprolactone (EG/CL)ratios ranging from 0.1 to 1.3. Starting from this single strategy, it was therefore possible to obtain nanospheres(DH ∼ 55 nm) or micelles (DH ∼ 30 nm) by copolymer self-assembly depending on the EG/CLratio. The potential of PCL-g-PEG micelles as drug carriers was finally evaluated with curcumin thatwas efficiently encapsulated, protected and released over 80 days. Interestingly it was found that drugencapsulation efficiency and drug loading were higher for PCL-g-PEG copolymers compared to blockPCL-b-PEG

Post-operative pain after vital pulpotomy of primary molars using allium sativum oil versus mineral trioxide aggregate: A randomized pilot clinical study

Aim: To evaluate clinical and radiographic performance of Allium Sativum oil dressed in Zinc Oxide versus Mineral trioxide aggregate as pulp dressing agent in pulpotomized lower primary molar teeth. Methodology: This randomized pilot clinical trial included 30 lower primary molars indicated for vital pulpotomy and randomly allocated into two equal groups (n=15): Group (I): pulpotomy using A. Sativum oil dressed in ZnO and Group (II): pulpotomy using Mineral trioxide aggregate as pulpotomy agent. All molars were covered with stainless steel crowns and clinical and radiographic assessment was done at 3, 6, 9 and 12 months interval by help of predetermined criteria. Results: Overall clinical success rate of Group (I) and Group (II) at the end of 12 months follow-up was (93.3%) and (100.0%) respectively. There was no statistical significance difference between two groups regarding overall clinical success rate. The overall radiographic success rate at the end of 12 months was (40.0%) and (100.0%) respectively. There was a statistical significant difference regarding overall radiographic success rate at 9 and 12 months follow-up. The overall success rate of Group (I) and Group (II) at the end of 12 months was (40.0%) and (100.0%) showing a statistically significant difference between the two groups

Clostridium perfringens panophthalmitis and orbital cellulitis: a case report

Abstract Background Clostridium perfringens is an uncommon pathogen in endophthalmitis, causing rapid destruction of ocular tissues. Clostridium perfringens infection typically occurs after penetrating injury with soil-contaminated foreign bodies. Case report Here, we describe the case of a 17-year-old male who sustained a penetrating injury with a metallic intraocular foreign body and who rapidly developed severe C. perfringens panophthalmitis with orbital cellulitis. He was managed by systemic and intravitreal antibiotics, resulting in preservation of the globe, but a poor visual outcome. Conclusion Clostridial endophthalmitis secondary to penetrating injuries is a fulminant infection, almost always resulting in loss of the globe in the case of advanced infection. When feasible, early vitrectomy and intravitreal antibiotics should be considered in patients with penetrating eye injuries with contaminated foreign bodies

Iterative Photoinduced Chain Functionalization as a Generic Platform for Advanced Polymeric Drug Delivery Systems

International audienceAdvanced drug delivery systems (DDS) are easily designed following a photoiterative strategy. Multifunctional polymers are obtained by coupling building blocks of interest to an alkynated PCL platform via an efficient thiol-yne photoaddition. Fine tuning over the design is achieved as illustrated with targeting and enzyme-responsive DDS.-

Stem cell therapy as a novel therapeutic intervention for resistant cases of alopecia areata and androgenetic alopecia

Background: Management of alopecia areata (AA) and androgenetic alopecia (AGA) is often challenging as patients may be resistant to currently available modalities of treatment. The use of stem cells may be a novel option for resistant cases. Objective: To evaluate the safety and efficacy of the use of autologous bone marrow derived mononuclear cells (including stem cells) as compared to follicular stems cells for the management of resistant cases of AA and AGA. Methods: This study included 40 patients (20 AA patients and 20 AGA patients), all patients were treated with a single session of intradermal injection of autologous stem cells (SCs) therapy. They were divided into four groups according to the applied modality [either autologous bone marrow derived mononuclear cells (bone marrow mononuclear cells [BMMCs] or autologous follicular stem cells [FSC]). Results: Six months after stem cell therapy (SCT) injection, there was a significant improvement, confirmed by immunostaining and digital dermoscopy. The mean improvement in all groups was “very good”. There was no significant difference between both methods in either type of alopecia. No serious adverse events were reported. Conclusion: Autologous BMMCs and FSC seem to be a safe tolerable and effective treatment for the management of both resistant AA and AGA